I was diagnosed with Herpes II 5 years ago. Just last week I developed a cold sore for the first time ever. Could this be a possible symptom of HIV? Also - what treatment (if not acyclovir cream/L-Lysine) do you recommend for this? I teach school and it is very embarrassing. Thanks for any info you have.

Response from Dr. Reznik

Cold sores, per se, are not diagnostic of HIV infection. Remember, there are not any oral manifestations that we see in association with HIV infection that are solely seen in this patient population, therefore the presence of these lesions would at best be suggestive of an underlying condition, not diagnostic. In the case of cold sores, they would not even be suggestive of HIV infection unless they did not heal within a reasonable period of time.

Treatment would depend on where the core is, which would be helpful in diagnosing what particular lesion is occurring. People tend to call both aphthous and herpetic ulcerations cold sores. If you have a history of herpetic outbreaks and the lesion is on your lips, it would not be unreasonable to assume you are experiencing a herpetic outbreak. These lesions, in immunocompetent people tend to resolve on their own. I would not recommend use of acyclovir cream as this tends to be more of a bandage than an actual treatment. Systemic acyclovir would be the medication of choice at a does of approximately 1 gram per day. If the lesion is inside your mouth on non-fixed tissue or non-keratinized tissues such as the inside of your cheeks or floor of your mouth, you are most likely suffering from an aphthous ulceration. Again, these sores tend to heal on their own in immnocompetent people, but relief can be obtained by using a topical steroid rinse.

Please have someone who is experienced with diagnosing these lesions take a look before you proceed with any therapy.

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